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Most prospective studies on DM amputations have not shown footwear to be the major risk factor - this one from Diabetes Care did:
Quote:
Explanations for the High Risk of Diabetes-Related Amputation in a Caribbean Population of Black African Descent and Potential for Prevention
Anselm J.M. Hennis, Henry S. Fraser, Ramesh Jonnalagadda, John Fuller, and Nish Chaturvedi
Quote:
OBJECTIVE—Diabetes-related lower-extremity amputation (LEA) rates are elevated in blacks compared with whites in the U.S., but are lower in African Caribbeans in the U.K., whereas anecdotal reports suggest high rates in the Caribbean. We aimed to establish the incidence and risk factors for diabetes-related LEA in a Caribbean population.
RESEARCH DESIGN AND METHODS—We conducted an incident and prospective case-control study of case patients (individuals with diabetes having a LEA) and community-based control subjects (individuals with diabetes without a LEA) in Barbados, West Indies. Participants completed an interview and examination of risk factors for amputation, including footwear use.
RESULTS—The overall 1-year incidence of LEA (n = 223) was 173 per 105 population and 936 per 105 population with diabetes (557 per 105 for minor amputation and 379 per 105 for major amputation). Women had higher amputation rates than those reported in the Global Lower Extremity Amputation Study, apart from the U.S. Navajo population. Independent risk factors for all diabetes-related LEAs were poor footwear (odds ratio [OR] 2.71 [95% CI 1.23–5.97]), elevated GHb (1.40 per percent increase [1.26–1.57]), peripheral neuropathy (1.05 per volt increase [1.03–1.08]), and peripheral vascular disease.
CONCLUSIONS—Diabetes LEA rates in Barbados are among the highest in the world. Inadequate footwear independently tripled amputation risk. Education of professionals and patients, particularly about footwear and foot care, coupled with improved diabetes clinical care, is key to reducing amputation risk in this population.
We recently conducted an audit of our outpatients footwear, where the general demagraphics were 65% DM, 35% PVD. 55% Male 45% Female.
We looked at shoe style, material, Closure and fit, and made assessment of the footwear's general appropriatness, based upon "good shoe guidelines" and the appropriatness of the shoe to the patient using both "good shoe guidlines' and patient charecteristics (eg foot lessions, Phx ulcer, -ve 10 filament, no pulses etc.)
The results were interesting in that:
Gender
There was no difference between males and females in the Appropriateness of shoe to the patients, but women were more likely to wear footwear lower in General Appropriateness.
Women were more likely to wear footwear without fastenings, and of poorer fit with 20% of their shoes considered too small. This was further reflected with females having twice the number of apical corns than males.
Diabetes
Patients with diabetes made acceptable footwear choices only 55% of the time. They were found to be make poorer footwear choices, with 30% wearing shoes with no form of closure. The general appropriateness of the shoes were lower than average and 40% of patients were wearing shoes than were considered inappropriate or damaging to the patients foot health.
Vascular Disease
Patients with vascular disease (either PVD or venous insufficiency) were more than twice as likely to were shoes considered damaging to there feet.
So why did this happen despite our repeated education of our patients? It may be to do with the poor funding of specialist footwear, but has more to do with patients not wanting to spend more than $20 on shoes. Often the signs of an at risk foot are not clearly evident to the patient, and they are not aware that their neuropthy has progressed, despite education and filament testing etc. and believe that the shoe style they have been wearing for the last 10 years are still OK. I Think
__________________ Stephen Tucker Eastern Health
Podiatry Manager
Inadequate footwear tripled risk for amputation
Footwear audit
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